Circle of Life: How Risk Adjustment Completes Your VBC Picture

When you finally see how the pieces connect, value-based care stops being confusing — and starts making sense.

Last week, we crowned you HCC royalty. You realized that your documentation isn’t just about billing — it’s about resourcing the care your patients truly need. You stopped settling for risk scores that don’t reflect reality and started building systems that elevate your impact.

But here’s the truth: risk adjustment isn’t just one more box to check.

It’s the trunk of the tree holding up your entire value-based care strategy.
It touches everything — outcomes, resourcing, patient trust, team morale, contract performance.

Which brings us to The Lion King.

Because value-based care has its own ecosystem. And just like in the Pride Lands, everything is connected.

Risk Adjustment Is the Root System of VBC

Think of risk adjustment as the baobab tree — deeply rooted, central to everything, and easy to overlook if you’re not paying attention.

When it’s working, your entire system thrives.

• You receive appropriate per-member-per-month (PMPM) payments based on complexity

• You can invest in care coordinators, chronic care management, and extended visits

• You’re held to quality benchmarks that match your patient population

• You stop fighting for scraps to do the work you’re already doing

But when it’s broken?

• You’re providing high-complexity care on low-complexity funding

• You’re rushed, reactive, and under-resourced

• Your outcomes suffer — not because of the care, but because of the constraints

• And your data paints an inaccurate picture that follows you into every future contract negotiation

The system thinks your patients are well.
You know better.
But unless it’s documented, coded, and captured — it doesn’t count.

The Circle Is Real — And It’s Ongoing

Here’s what most people miss: risk adjustment is a cycle, not a one-time event.

• Your documentation feeds your risk scores

• Those scores influence your funding

• Your funding impacts your ability to deliver comprehensive care

• That care drives your quality outcomes

• And your outcomes shape your reputation, contract terms, and growth

Then it starts all over again — with new patients, new needs, and new expectations.

You can’t separate clinical care from financial reality anymore. If you’re in value-based care, risk adjustment is part of your clinical work.

Every Season Has Its Strategy

Just like the Pride Lands cycle through dry and rainy seasons, risk adjustment has a rhythm. If you understand the seasons, you can plan, allocate, and perform more consistently.

• Q1: Review the previous year. Update templates, retrain staff, refresh coding accuracy goals.

• Q2: Begin tracking patterns. Are high-risk patients getting their conditions captured? What’s slipping through the cracks?

• Q3: Tighten the gaps. This is when a structured audit can catch missed opportunities while there’s still time to address them.

• Q4: Finalize, don’t scramble. Your systems should already be working. Now’s the time for last clinical confirmations, not crisis coding.

Each quarter has a role. But your foundation has to be built early — otherwise you’ll always be playing catch-up.

Leadership Means Seeing the Whole Picture

This is where your Simba moment happens.

Leadership in value-based care means seeing the ecosystem — not just your piece of it. And helping your team understand how they fit.

• Clinicians don’t need to become coders — but they need to understand why specificity matters

• Coders don’t need to interpret clinical nuance alone — they need access, context, and feedback

• Admin teams can’t drive performance if they’re disconnected from day-to-day documentation behavior

• Everyone needs aligned goals, shared wins, and clarity on how risk adjustment supports patient care — not just payment

The most successful practices I’ve seen build cultures where documentation is part of care — not an afterthought. Where data flows are intentional. Where coders and clinicians talk.

That doesn’t happen by accident. It happens because leadership made it happen.

Don’t Fall for the “Hakuna Matata” Trap

It’s tempting to think: “If I just focus on patient care, the rest will sort itself out.”

Unfortunately, that’s the fastest way to fall behind in value-based care.

You can provide excellent care — and still have poor risk capture.
You can mean well — and still under-resource your team.
You can delegate documentation — and still be missing half the story.

No worries is a great motto for vacation. But not for sustainable care delivery.

Documentation and coding need systems, oversight, and teamwork. Because they’re not just tasks — they’re tools. When used right, they unlock the support you’ve been asking for.

Risk Adjustment Is a Team Sport

Every team needs its Timon and Pumbaa — those people who bring different strengths, solve different problems, and have your back no matter what.

Risk adjustment works the same way:

• Clinicians bring insight into patient complexity

• Coders translate that insight into accurate codes

• Admin and operations teams build the workflows, dashboards, and training that keep everything moving

None of those parts can function well in isolation. But when they work together? That’s where excellence lives.

If you want a healthy VBC model, your risk adjustment team can’t be an afterthought. It has to be a core part of how you run the practice.

Legacy-Level Leadership

Simba didn’t just reclaim the throne. He rebuilt a broken ecosystem.

That’s the level of leadership we’re aiming for in risk adjustment.

Because this isn’t just about better data. It’s about what better data unlocks:

• Longer visits

• Proactive care teams

• Patient education

• Trust

• Better contracts

• Growth

Risk adjustment may not be flashy. But it’s foundational. And if you want to lead a sustainable, equitable, high-performance care model — this is the work.

Everything in VBC is connected. Documentation, coding, outcomes, funding, burnout, staffing, growth — it’s all part of the same system. And risk adjustment is the quiet engine that makes the rest of it run.

The Circle of Life is real. And your leadership is what keeps it turning.

Let’s build something that lasts.